Diabetic Peripheral Neuropathy Screening Process In Clinical Studies

Background Diabetes mellitus is a chronic, non-infectious and life-long metabolic disease characterizedby elevated plasma glucose levels. Type2diabetes mellitus （T2DM）accounts for90%～95%of the totaldiabetes mellitus population in china.The prevalence of T2DM is gradually increasing, which has become aserious public health problem.Diabetic peripheral neuropathy(DPN) is one of the most frequent happened complications of thediabetes mellitus. The incidence of DPN is correlated with the course of diabetes mellitus. Courses formore than ten years, DPN often appear obvious clinical symptoms and cause high mutilation rate or highlethality rate,So the early detection and treatment of DPN has important clinical significance. This studyhas employed neural electrophysiological examination as the gold standard to evaluate the clinicalapplication value of diabetic peripheral neuropathy screening processes and Toronto clinical scoring system,aimming at finding a good DPN screening method for large scale clinical applications.Purpose Discussion on " diabetic peripheral neuropathy screening process " in diagnosis of peripheralneuropathy in diabetic patients, looking for a economic, simple and accurate method of screening fordiabetic peripheral neuropathy.Methods To collect816cases of type2diabetes in the clinics and wards of the Henan Provincial People’sHospital from September2010to January2012.every patient was examined Nerve ConductionVelocity(NCV),Somatosensory evoked potential(SEP), Toronto Clinical Scoring System(TCSS）and DPNat the same time. Compared the diagnostic value of TCSS and DPN screening process while takenelectroneuromyogyaphy as a “gold standard” to calculate the two kinds of screening sensitivity, specificity,positive predictive value, negative predictive value and Youden index.Results1. There are different types of DPN symptoms in patients with diabetes, numbness46.02%, pain15.71%, feeling abnormal16.59%, acupuncture sense of12.17%, others such as weak10.62%.2.Achillestendon reflex anomaly37.17%, knee jerk exception29.42%, pressure sensation disappears4.65%,vibration sensation lost15.49%, needle felt exception25%.The sensitivity and specificity of the pressure perception were19.44%and95.62%respectively, the sensitivity and specificity of vibration perceptionwere77.78%and60.87%respectively, the sensitivity and specificity of temperature sensation were35.19%and89.13%respectively, the sensitivity and specificity of acupuncture perception were31.48%and84.78%respectively.3. Through the electroneuromyogyaphy test514people were positive(accounting for62.99%).4. DPN602patients are positive (accounting for73.77%),With nerve electrophysiologicalexamination as standard, the sensitivity, specificity, positive predictive value, negative predictive value andYouden index of DPN screening processes were89.49%,66.56%,81.99%,78.82%and0.5605.5. TCSS458patients are positive (accounting for56.13%). TCSS score≥6in TCSS screening table sensitivity,specificity, positive predictive value, negative predictive value and Youden index were78.21%,84.11%,89.33%,69.40%and0.6232respectively,0-5，51.33%,6-8,29.65%,9-11,-9.07%, more than11,9.96%.6.averagely DPN screening process takes about5.89minutes, TCSS screening table takes approximately10.32minutes.Conclusion Take electroneuromyogyaphy as a “gold standard”,DPN screening process is a economic,simple and accurate method, It is suitable for screening early diabetic peripheral neuropathy in patientswith or without clinical applications.